title: Effectiveness of decentralized community-based screening, detection, and treatment of breast cancer in low-income, uninsured women.
abstract: Different systems exist currently in the provision of breast care to low-income, uninsured women. We assessed the efficacy of screening, diagnosis, and treatment of breast cancer in this patient population through a decentralized network of providers. We retrospectively reviewed charts of all patients referred for evaluation and treatment under the Cancer Detection Program: Every Woman Counts (CDP:EWC), the California equivalent of the National Breast and Cervical Cancer Detection and Prevention Program, in a suburban area of Los Angeles County. A total of 972 CDP:EWC screening mammograms was performed in the Antelope Valley during a 7-year study period (2000 to 2007). Sixty-two screened women aged 40 to 64 years were referred for further evaluation. Breast cancer detection rate per screening mammogram was 0.8 per cent; 80 per cent were early-stage breast cancer. The majority of the women (nine of 15) underwent breast conservation surgery. The axilla was staged using sentinel lymph node dissection and/or axillary lymph node dissection. Adjuvant chemotherapy and radiation were administered to all eligible patients. Compliance with published practice guidelines was high. This suggests that a decentralized community-based network of providers may be an effective model to deliver breast care to a low-income, uninsured patient population.
authors.affiliation: Department of General and Oncologic Surgery, City of Hope, Duarte, California 91010, USA.
authors.forename: Achala
authors.initials: A
authors.lastname: Bhaskara
authors.forename: Maria
authors.initials: M
authors.lastname: Altamirano
authors.forename: Vijay
authors.initials: V
authors.lastname: Trisal
authors.forename: I Benjamin
authors.initials: IB
authors.lastname: Paz
authors.forename: Lily L
authors.initials: LL
authors.lastname: Lai
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D002140:California / Q000453:epidemiology; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008327:Mammography / Q000379:methods*; D008403:Mass Screening / Q000379:methods*; D017057:Medically Uninsured; D008875:Middle Aged; D009017:Morbidity; D011203:Poverty; D015203:Reproducibility of Results; D012189:Retrospective Studies